Application Agreement

By submitting an application for insurance and the first premium payment installment, you agree to the terms and conditions of the following application agreement.

I agree that this application for pet insurance will not result in coverage if I have intentionally or unintentionally misrepresented the health, age, breed, home address, owner or other material fact on this application.

I authorize you to obtain the medical history of my pet(s) directly from my veterinarian or other health care provider for my pet(s) both for purposes of issuance of this policy, and to underwrite or determine eligibility of any claim submission under this policy.

I agree that you have authorization to collect payment(s) for premiums as I have selected from my choices of payment for this
application.

I agree that you may continue to collect payments as I have directed to keep the policy enforceable until such time as I notify you in writing or by e-mail.

I agree to keep you apprised of any changes to my account information (checking account number, credit or debit card number,
mailing address and/or expiration dates) to allow continued payment on my account.

I certify that I am at least 18 years old at the time of this application

I acknowledge that the inability to process payments due to inaccurate or old account information may result in the lapse or
cancellation of my policy.

I understand that the policy I am purchasing is being sold on an annual basis and that my coverage will be bound for a period of
three-hundred and sixty-five (365) days. I will be eligible to request changes to my policy and coverage at my renewal date which will be clearly listed on my declarations page.

I acknowledge that the insured pet(s) belong to me, that I am primarily responsible for their veterinary bills and that the pet(s) reside with me at the address listed on this application.

I understand that pre-existing conditions will not be covered:I acknowledge understanding that a pre-existing condition is any condition that was present prior to the original policy effective date, whether or not the condition was diagnosed or treated previously, and is not covered under your Pets Best policy.

Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement containing any false, incomplete or misleading information is guilty of a felony.

Alabama residents:

Any person who knowingly presents a false or fraudulent claim for
payment of a loss or benefit or who knowingly presents false information
in an application for insurance is guilty of a crime and may be subject
to restitution fines or confinement in prison, or any combination
thereof.

Arkansas residents:

Any person who knowingly presents a false or fraudulent claim for
payment of a loss or benefit or knowingly presents false information in
an application for insurance is guilty of a crime and may be subject to
fines and confinement in prison.

Colorado residents:

It is unlawful to knowingly provide false, incomplete, or misleading
facts or information to an insurance company for the purpose of
defrauding or attempting to defraud the company. Penalties may include
imprisonment, fines, denial of insurance, and civil damages. Any
insurance company or agent of an insurance company who knowingly
provides false, incomplete, or misleading facts or information to a
policyholder or claimant for the purpose of defrauding or attempting to
defraud the policyholder or claimant with regard to a settlement or
award payable from insurance proceeds shall be reported to the Colorado
division of insurance within the department of regulatory agencies.

District of Columbia residents:

WARNING: It is a crime to provide false or misleading information
to an insurer for the purpose of defrauding the insurer or any other
person. Penalties include imprisonment and/or fines. In addition, an
insurer may deny insurance benefits if false information materially
related to a claim was provided by the applicant.

Florida residents:

Any person who knowingly and with intent to injure, defraud or
deceive any insurer files a statement of claim or an application
containing any false, incomplete or misleading information is guilty of a
felony of the third degree.

Kentucky residents:

Any person who knowingly and with intent to defraud any insurance
company or other person files an application for insurance containing
any materially false information or conceals, for the purpose of
misleading, information concerning any fact material thereto commits a
fraudulent insurance act, which is a crime.

Kansas residents:

Any person who knowingly presents false information in an
application for insurance is guilty of a crime and may be subject to
fines and imprisonment.

Louisiana residents:

Any person who knowingly presents a false or fraudulent claim for
payment of a loss or benefit or knowingly presents false information in
an application for insurance is guilty of a crime and may be subject to
fines and confinement in prison.

Maine residents:

It is a crime to knowingly provide false, incomplete or misleading
information to an insurance company for the purpose of defrauding the
company. Penalties may include imprisonment, fines or a denial of
insurance benefits.

Maryland residents:

ANY PERSON WHO KNOWINGLY OR WILLFULLY PRESENTS A FALSE OR FRAUDULENT
CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR WHO KNOWINGLY OR WILLFULLY
PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A
CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN PRISON.

New Jersey residents:

Any person who includes any false or misleading information on an
application for an insurance policy is subject to criminal and civil
penalties.

New Mexico residents:

ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR
PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN
AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO
CIVIL FINES AND CRIMINAL PENALTIES.

New York residents:

Any person who knowingly and with intent to defraud any insurance
company or other person files an application for insurance or statement
of claim containing any materially false information, or conceals for
the purpose of misleading, information concerning any fact material
thereto, commits a fraudulent insurance act, which is a crime, and shall
also be subject to a civil penalty not to exceed five thousand dollars
and the stated value of the claim for each such violation.

Ohio residents:

Any person who, with intent to defraud or knowing that he is
facilitating a fraud against an insurer, submits an application or files
a claim containing a false or deceptive statement is guilty of
insurance fraud.

Oklahoma residents:

WARNING: Any person who knowingly, and with intent to injure,
defraud or deceive any insurer, makes any claim for the proceeds of an
insurance policy containing any false, incomplete or misleading
information is guilty of a felony.

Oregon residents:

Any person who deceptively files a claim containing materially false
information with an intent to knowingly defraud an insurer may have
committed a crime.

Pennsylvania residents:

Any person who knowingly and with intent to defraud any insurance
company or other person files an application for insurance or statement
of claim containing any materially false information or conceals for the
purpose of misleading, information concerning any fact material thereto
commits a fraudulent insurance act, which is a crime and subjects such
person to criminal and civil penalties.

Rhode Island residents:

Any person who knowingly presents a false or fraudulent claim for
payment of a loss or benefit or knowingly presents false information in
an application for insurance is guilty of a crime and may be subject to
fines and confinement in prison.

Tennessee residents:

It is a crime to knowingly provide false, incomplete or misleading
information to an insurance company for the purpose of defrauding the
company. Penalties include imprisonment, fines and denial of insurance
benefits.

Virginia residents:

It is a crime to knowingly provide false, incomplete or misleading
information to an insurance company for the purpose of defrauding the
company. Penalties include imprisonment, fines and denial of insurance
benefits.

Washington residents:

It is a crime to knowingly provide false, incomplete, or misleading
information to an insurance company for the purposes of defrauding the
company. Penalties include imprisonment, fines, and denial of insurance
benefits.

West Virginia residents:

Any person who knowingly presents a false or fraudulent claim for
payment of a loss or benefit or knowingly presents false information in
an application for insurance is guilty of a crime and may be subject to
fines and confinement in prison.

Pet insurance coverage offered and administered by Pets Best Insurance Services, LLC is underwritten by Independence American Insurance Company,
a Delaware insurance company. Independence American Insurance Company is a member of The IHC Group, an organization of insurance carriers and
marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions
to groups and individuals for over 30 years. For information on The IHC Group, visit: http://www.ihcgroup.com.